Prelexical development of unilateral cleft lip and palate babies with reference to presurgical infant orthopaedics: a randomized prospective clinical trial

Presurgical infant orthopaedics (PIO) is widely used to treat children with clefts. However, consensus on the relevance of this treatment is lacking. A prospective clinical trial is under way to investigate the effects of PIO in unilateral cleft lip and palate (UCLP) babies. The prelexical development of two groups of UCLP babies was compared at 12 and 18 months of age; one group received PIO, while the other did not. Analysis of prelexical utterances was performed by means of a perceptually based sensori-motoric classification system. Consonant-like elements were also assessed by means of phonetic analysis of place and manner of articulation. At the age of 12 months the PIO babies showed enhanced use of alveolar articulations. However, the effect of PIO seemed to be transient, because the recordings obtained at 18 months showed similar use of all variables of sound production in the two groups. The longitudinal character of the clinical trial will enable the evaluation of the long-term effects of PIO as the children grow older.     

Nucleic Acids and Cytological Changes in the Thyroid Gland after Thiouracil.l

1) By the action of thiouracil the follicular cell is not brought into the state of physiological inactivity and it shows signs of apparent secretion which differ however in details remarkably from the effective secretion stage. 2.) The quantity of follicular cells in mitosis is temporarily increased to the multiple. This disturbance is the result of the inhibition of caryokinesis in the stage of metaphase. 3) The absolute quantities of ribonucleic and of desoxyribonu-cleic acid are considerably reduced. 4) The ratio KNA/DNA shows a decrease to a fractional part of the normal value, according to the increase of the cell mass.     

Relationship between Autonomic Innervation in Crista Terminalis and Atrial Arrhythmia

Background : The crista terminalis (CT) is known to initiate and maintain atrial arrhythmia, and is affected by autonomic tone, but the underlying mechanisms are poorly understood. This study sought to study the relation between autonomic innervation in CT and atrial arrhythmia.
Methods: Thirty adult canines were used in the present study. Tissues of the CT and the pectinate muscles (PM) were obtained from 10 dogs for electrophysiology studies. Furthermore, tissues of the superior CT, the inferior CT, and the PM were obtained from 10 dogs for immunohistochemistrical studies. Anti-growth-associated protein 43 (GAP43), anti-tyrosine hydroxylase (TH), and choline acetyltransferase (ChAT) antibodies for immunocytochemical staining of cardiac nerves were performed to test the densities of autonomic nerve. Densities of I_K,ACh in the superior CT, the inferior CT, and the PM cells were measured by patch clamp in the other 10 dogs.
Results: With the pacing cycle length decreased, the amplitude of delayed after depolarization (DAD) increased and DAD-induced triggered activity was induced in the CT but not in PM with norepinephrine administration. GAP-43 and TH-positive nerves in the superior CT and the inferior CT were all significantly higher than in the PM (GAP-43: 6,250 ± 1,928 vs 1,247 ± 747, 2,855 ± 1,579 vs 1,247 ± 747; TH: 3,140 ± 1,240 vs 690 ± 720, 1,210 ± 980 vs 690 ± 720; P < 0.01). Furthermore, the GAP-43 and TH-positive nerves in the superior CT were higher than in the inferior CT. However, there were no significant differences in ChAT-positive nerves and I_K,ACh in the superior CT, the inferior CT, and the PM.
Conclusions: The higher densities of adrenergic nerve in the CT play an important role in the genesis of atrial arrhythmia.     

Medicaid Waivers and Tenancy Supports for Individuals Experiencing Homelessness: Implementation Challenges in Four States

Policy Points

• Medicaid policymakers have a growing interest in addressing homelessness as a social determinant of health and driver of the potentially avoidable use of expensive medical services.
• Drawing on extensive document reviews and in‐depth interviews in four early‐adopter states, we examined the implementation of Medicaid''s Section 1115 demonstration waivers to test strategies to finance tenancy support services for persons experiencing or at risk of homelessness.

ContextThe Affordable Care Act extended Medicaid eligibility to large numbers of individuals experiencing or at risk of homelessness. This legislative development and the growing recognition of homelessness as a significant social determinant of health have encouraged advocates and policymakers to seek new ways to use Medicaid to provide housing supports.MethodsWe conducted 28 semistructured interviews with 36 stakeholders in four states. The stakeholders were government administrators, health care providers, nonprofit housing staff, and consultants. We supplemented these interviews with extensive reviews of public documents, media accounts, think‐tank reports, and published literature. We also conducted a systematic inductive qualitative analysis.FindingsWe identified seven challenges to the successful implementation of tenancy support demonstration projects: resolving the housing supply and NIMBY, removing silos between health care and homeless services providers, enrolling and retaining the target populations in Medicaid, contracting with and paying tenancy support providers, recruiting and retaining key workers, ensuring Medicaid''s waiver durability, and reducing administrative crowd‐out and waiver burden.ConclusionsNotwithstanding these challenges, three of the four states have made significant progress in launching their initiatives. At this point, the fourth state has delayed its start‐up to consider alternatives to a Medicaid demonstration waiver to provide tenancy supports. The experience of the four states suggests lessons for Medicaid officials in other jurisdictions that are interested in pursuing tenancy support initiatives. Nevertheless, the limitations of tenancy support waiver programs suggest that federal policymakers should consider allowing states to more directly subsidize housing costs for those experiencing or at risk of homelessness as an optional Medicaid benefit.     

Side Effects and Complications of Fractional Laser Photothermolysis: Experience with 961 Treatments

BACKGROUND A novel 1,550-nm erbium-doped laser (Fraxel, Reliant Technologies Inc.) has been shown to be effective in the treatment of photodamaged skin and scars with minimal postoperative recovery; however, studies evaluating its side effects and complication rates have been limited.
PURPOSE The purpose was to determine the frequency and range of side effects and complications associated with fractional photothermolysis treatment.
METHODS A retrospective evaluation of 961 successive 1,550-nm erbium-doped laser treatments in patients of various skin phototypes (I–V) was conducted in a single center. Side effects and complications of treatment, including time of onset and duration, were identified and tabulated. Patient demographics and laser parameters were also assessed.
RESULTS Seventy-three treatments (7.6%) resulted in development of complications. The most frequent complications were acneiform eruptions (1.87%) and herpes simplex virus outbreaks (1.77%). Side effects and complications were equally distributed across different ages, skin types, body locations, laser parameters, and underlying skin conditions, except for postinflammatory hyperpigmentation, which occurred with increased frequency in patients with darker skin phototypes.
CONCLUSIONS Fractional laser skin treatment is associated with a relatively low complication rate. Side effects and complications observed in this study were temporary and did not result in long-term or significantly severe sequelae (e.g., scarring).